ENDOSTAB: an endoscopic pressure stabiliser for minimally-invasive cardiacsurgery using specially etched superelastic NiTi wires for joint-like behaviour

For a long time, the only way to access the heart for a bypass operation wa s to sever the sternum (median sternotomy). Encouraged by the successes ach ieved by minimally-invasive surgery in other fields, cardiosurgery underwen t rapid development, which eventually enabled thoracoscopic operations of t he heart. Only with the development of complex robot systems and telesurger y, however, did it become possible to perform exclusively endoscopic bypass operations. Today, the heart-lung machine (HLM) is used as a standard devi ce for bypass operations, with cardiac arrest induced by an infusion. Studi es have shown that the HLM may lead to a significant inflammatory reaction and that it is advantageous, particularly for patients with bad cardiac fun ction, to avoid cardiac arrest and keep the heart continuously supplied wit h blood. 'Stabilisers' have been developed to enable bypass operations on t he beating heart without using an HLM. For operations on the beating heart using an exclusively endoscopic robot system, an endoscopic stabiliser has been developed, in cooperation with the Leipzig Cardiovascular Institute. T he stabilisers that are already available are rigid and, hence, only suitab le for an 'open' intervention, in conjunction with a retractor. Based on a flexible, superelastic unit made of NiTi, a stabiliser has now been develop ed that allows endoscopic insertion via a tube of 10 mm in diameter. Joint- like behaviour is achieved by the shaping of the NiTi wires and the specifi c removal of material in the curved areas. In the operating state, the stab iliser is still rigid enough to immobilise the desired vascular section. Th e ENDOSTAB endoscopic stabiliser has already been successfully used in anim al experiments at the Leipzig Cardiovascular Institute. The way is thus pav ed for exclusively endoscopic bypass operations on the beating heart withou t the use of an HLM.